2013-11-12T11:59:10-06:00 2012-12-31 161226221 FUST CHARLES CHAMBERS LLP 5784 WIDEWATERS PARKWAY SYRACUSE NY 13214 990 2012-01-01 222229425 ROCHESTER GENERAL HOSPITAL FOUNDATION INC ROCH 5859224800 100 KINGS HIGHWAY SOUTH NO 2300 ROCHESTER NY 14617 PAULA TINCH 5859224800 2013-11-06 1 ANGELA M FRANCO P00589741 3154463600 2012 2016-02-24 21:20:13Z MARK C CLEMENT 100 KINGS HIGHWAY SOUTH NO 2300 ROCHESTER NY 14617 5827876 0 X WWW.ROCHESTERGENERAL.ORG X 1988 NY TO CONDUCT ACTIVITIES THAT RAISE FUNDS AND TO INVEST SUCH FUNDS FOR THE BENEFIT OF THE ROCHESTER GENERAL HOSPITAL AND ITS AFFILIATED ORGANIZATIONS. 27 22 11 27 0 0 4299404 4415887 0 0 2296756 1057001 -487354 -421328 6108806 5051560 5624482 2920962 0 0 1371494 1312604 0 142105 798407 1193844 1221562 8189820 5597233 -2081014 -545673 38220562 36621400 5278532 2813087 32942030 33808313 X TO PROVIDE FUNDS TO OR FOR THE BENEFIT OF ROCHESTER GENERAL HOSPITAL AND AFFILIATES BY:A) SOLICITING, ACCEPTING, HOLDING, INVESTING, REINVESTING AND ADMINISTERING ANY GIFTS, BEQUESTS, DEVISES, BENEFITS OF TRUSTS AND PROPERY OF ANY SORT, WITHOUT LIMITATION AS TO AMOUNT OR VALUE;B) USING, DISBURSING OR DONATING THE INCOME OR PRINCIPAL THEREOF EXCLUSIVELY FOR THE FOREGOING PURPOSES; ANDC) PERFORMING ANY OTHER ACT OR THING INCIDENTAL TO OR CONNECTED WITH THE FOREGOING PURPOSES OR IN ADVANCEMENT THEREOF. 0 0 3255757 2920962 SEE SCHEDULE OTHE ROCHESTER GENERAL FOUNDATION CONDUCTS A BROAD RANGE OF FUNDRAISING EFFORTS TO DRIVE ANNUAL GIVING, SPECIAL EVENT SUPPORT, MAJOR GIFTS AND PLANNED GIFTS. EVENT - IN 2012, THE FOUNDATION CONDUCTED MULTIPLE SPECIAL EVENTS. EACH EVENT WAS DESIGNED WITH THE PURPOSE OF RAISING MONEY, THANKING MAJOR DONORS OR CULTIVATING NEW MAJOR DONORS. SOMETIMES, EVENTS ACCOMPLISHED TWO OR THREE OF THESE OBJECTIVES. THIS SECTION DESCRIBES SOME HIGHLIGHTS OF 2012 ROCHESTER GENERAL HOSPITAL FOUNDATION EVENTS.THE MOST SIGNIFICANT EVENT OF THE YEAR, THE FOUNDERS SOCIETY GALA, WAS HELD IN NOVEMBER 2012. APPROXIMATELY, 1,400 PEOPLE ATTENDED THE EVENT AND RAISED OVER $793,000 - A RECORD AMOUNT - BEFORE EXPENSES. ADDITIONALLY, SIX PEOPLE WERE RECOGNIZED AS PHILANTHROPY AWARD HONOREES. THIS WAS AN OPPORTUNITY TO THANK THEM FOR THEIR SUPPORT OF THE HEALTH SYSTEM. THIS EVENT WAS ALSO AN OPPORTUNITY TO ENGAGE PROSPECTIVE MAJOR DONORS TO MAKE FUTURE GIFTS TO THE CAPITAL CAMPAIGN.LUNCH AND DINNER EVENTS DESIGNED TO THANK, EDUCATE AND INSPIRE FRIENDS OF ROCHESTER GENERAL HEALTH SYSTEMS WERE PEPPERED THROUGHOUT THE YEAR AS WELL. THE FOUNDERS SOCIETY LUNCHEON, THE HANSFORD LEGACY SOCIETY DINNER AND THE BOARD EMERITUS SOCIAL WERE THE MOST NOTABLE EXAMPLES OF THE FOUNDATION THANKING PAST FRIENDS AND DONORS FOR THEIR GENERAL SUPPORT WHILE ALSO ENLIGHTENING THEM ON THE FUTURE NEEDS OF THE SYSTEM AND NEW WAYS TO LEND PHILANTHROPIC SUPPORT IN THE FUTURE.THE FOUNDATION ALSO HELD SEVERAL PRIVATE EVENTS THAT WERE MEANT TO CULTIVATE PROSPECTIVE DONORS TO THE CAMPAIGN. PAST DONORS AND PEOPLE WHO PREVIOUSLY HAD LITTLE CONTACT WITH THE HEALTH SYSTEM WERE INVITED TO "INSIDER EVENTS", WHERE HEALTH SYSTEM LEADERS AND PROMINENT COMMUNITY SUPPORTERS SHARED NEEDS AND ASPIRATIONS FOR THE HEALTH SYSTEM AND THE REGION AT LARGE.ANNUAL GIVING -THE FOUNDATION ALONG WITH NEWARK-WAYNE COMMUNITY HOSPITAL FOUNDATION, CONTINUED A DIRECT MAIL PROGRAM TO ACQUIRE MORE THAN 2,300 NEW DONORS SINCE 2012. AS PART OF THE PLANNED PROGRESSION TOWARD THE CAMPAIGN, 2012 MARKED A YEAR WHEN ACQUISITION EFFORTS WERE REDUCED AND RETENTION EFFORTS WERE EXPANDED. THIS MEANS WE FOCUSED ON MAINTAINING CONTACT WITH THE DONORS WE HAVE ACQUIRED OVER THE PAST THREE YEARS, ENCOURAGING REPEAT GIFTS FROM THEM INSTEAD OF CONTINUTING TO FOCUS ON FINDING NEW DONORS. WHILE THIS EFFORT BENEFITS BOTH FOUNDATIONS, WHEN APPROPIATE, DIRECT MAIL EFFORTS WERE TARGETED TO THE "NEWARK WAYNE" COMMUNITY AND THE "ROCHESTER GENERAL" COMMUNITY.AS THE CAMPAIGN CONTINUES TO PROGRESS, MAJOR GIFT OFFICERS WILL TRY TO REACH OUT TO INDIVIDUALS WHO HAVE MADE MULTIPLE GIFTS AND SATISFY OTHER QUALIFYING CRITERIA TO ENCOURAGE EITHER A MAJOR GIFT OR A PLANNED GIFT. 3255757 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 49 0 1 11 1 0 0 0 0 0 1 1 0 0 0 0 0 X 27 22 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 NY X TAMMY CLAFLIN 5859221745 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 TRENT BRIDGES 1.00 X 0 0 0 DAVID N BROADBENT MD 1.00 X 0 0 0 DONALD S CAMERON 1.00 X 0 0 0 KEVIN T CANNAN 1.00 X 0 0 0 KEVIN J CASEY MD 1.00 39.00 X 0 400244 62119 CYNTHIA CHRISTY MD 1.00 39.00 X 0 0 0 CHARLES T EAGLE JR 1.00 X 0 0 0 LOUISE W EPSTEIN 1.00 X 0 0 0 JACK A ERDLE 1.00 X 0 0 0 ROBERT W GEORGE SR MD 1.00 39.00 X 0 60010 6194 GREGORY P KAUSCH 1.00 X 0 0 0 PETER A KOUIDES MD 1.00 39.00 X 0 376099 54003 JEFFREY LEENHOUTS CFP CHFE CLU 1.00 X 0 0 0 CARL J LUGER 1.00 X 0 0 0 JAMES T MAXWELL MD 1.00 X 0 0 0 WILLIAM B MENDICK 1.00 X 0 0 0 ANGELO MICCICHE 1.00 X 0 0 0 LEONARD OLIVIERI 1.00 X 0 0 0 KEVIN OVERTON ESQ 1.00 X 0 0 0 RALPH P PENNINO MD 1.00 39.00 X 0 512965 99376 MICHAEL E PICHICHERO MD 1.00 39.00 X 0 657703 54843 WANDA POLISSENI 1.00 X 0 0 0 JOSEPH R RULISON 1.00 X 0 0 0 KATHERINE T SCHUMACHER 1.00 X 0 0 0 ANTHONY F SOLAZZO MD 1.00 X 0 0 0 JOHN R VALVO MD 1.00 X 0 0 0 ETHAN L WELCH MD 1.00 X 0 0 0 JOSEPHINE BRAITMAN 1.00 X 0 0 0 FREDDIE CALDWELL 1.00 X 0 0 0 SAMUEL HUTSON 1.00 X 0 0 0 STEVEN SCHWARTZ 1.00 X 0 0 0 DON TWIETMEYER 1.00 X 0 0 0 ROBERTA VANWINKLE 1.00 X 0 0 0 JOSEPH VASILE MD 1.00 39.00 X 0 374576 64228 MARK CLEMENT 1.00 54.00 X 0 1385174 712572 PAULA TINCH 1.00 54.00 X 0 261157 57140 JAMES DIGAN 20.00 20.00 X 495256 0 131446 495256 4027928 1241921 1 0 1 0 0 751633 4390 3659864 206255 4415887 1237001 1237001 180000 -180000 -180000 -180000 174988 751633 596316 -421328 -421328 5051560 0 0 635673 2920962 2920962 626702 313351 313351 592928 296464 296464 92974 46487 46487 6350 6350 14126 14126 142105 142105 14370 14370 31928 31928 96507 96507 79475 79475 32996 32996 PROGRAM EXPENSE 334795 334795 UNCOLLECTIBLE PLEDGES 283254 283254 CHANGE IN GIFT ANNUITY 102496 102496 225265 225265 5597233 3255757 1543069 798407 1556869 1019153 2173954 1006100 9415127 8488389 33708 153458 967059 85378 938370 881681 11575467 9580590 12527067 15475514 0 16515 38220562 36621400 456650 562567 86607 214502 4735275 2036018 5278532 2813087 X 1836768 1943117 22999118 23757759 8106144 8107437 32942030 33808313 38220562 36621400 -545673 1411956 0 X X 0 1 X 1 1 1 X X X 0 0 0 ROCHESTER GENERAL HOSPITAL 160743134 3 1 1 1 2869046 ROCHESTER GENERAL LONG TERM CARE 223187140 9 1 1 1 41923 ROCHESTER MENTAL HEALTH CENTER 166069131 3 1 1 1 5253 INDEPENDENT LIVING FOR SENIORS 161491059 3 1 1 1 4740 4 2920962 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 8106143 1294 8107437 8043862 62281 8106143 7960615 83247 8043862 7955419 5196 7960615 7924901 30518 7955419 1.00000 0 0 510000 510000 457059 85378 371681 881681 COMMON COLLECTIVE TRUSTS 2748686 F HEDGE FUNDS 12726828 F 15475514 DUE TO AFFILIATES 925525 CHARITABLE GIFTS ANNUITY LIABILITY 1110493 2036018 5827876 776316 776316 5051560 0 5051560 6373549 776316 776316 5597233 0 5597233 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS INCLUDE: 1) CAPITAL EXPANSION AND IMPROVEMENT 2) ADVANCEMENT OF MEDICAL EDUCATION AND RESEARCH AND HEALTH CARE SERVICES. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 596,316. IMPAIRMENT LOSS 180,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 596,316. IMPAIRMENT LOSS 180,000. X X X 1 CHAD GOBEL AND ASSOCIATES 2 STATE STREET SUITE 1150 ROCHESTER NY 14614 CONSULTING 0 0 73174 73174 CCS 461 FIFTH AVENUE 3RD FLOOR NEW YORK NY 10017 CONSULTING 0 0 68931 68931 142105 142105 GALA 793350 624405 168945 553216 RODEO 133271 127228 6043 43100 0 926621 751633 174988 596316 596316 -421328 1 ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 2869046 PROJECT FUNDING ROCHESTER MENTAL HEALTH CENTER 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 5253 PROJECT FUNDING INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 4740 PROJECT FUNDING ROCHESTER GENERAL LONG TERM CARE 1550 EMPIRE BOULEVARD WEBSTER NY 14580 223187140 41923 PROJECT FUNDING 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CHECK REQUESTS AND PURCHASE ORDERS ARE REVIEWED FOR APPROPRIATE AUTHORIZATION AND USE OF FUNDS PRIOR TO ISSUANCE OF PAYMENT. SCHEDULE I, PART II: ALL CONTRIBUTIONS ARE GIVEN SOLELY TO RELATED EXEMPT ORGANIZATIONS. X X 1 1 0 1 0 0 0 0 0 0 0 KEVIN J CASEY MD 0 169427 0 206353 0 24464 0 54258 0 7861 0 462363 0 0 PETER A KOUIDES MD 0 192825 0 150540 0 32734 0 45173 0 8830 0 430102 0 0 RALPH P PENNINO MD 0 482501 0 20000 0 10464 0 89621 0 9755 0 612341 0 0 MICHAEL E PICHICHERO MD 0 276297 0 355324 0 26082 0 44524 0 10319 0 712546 0 0 JOSEPH VASILE MD 0 280069 0 66844 0 27663 0 54673 0 9555 0 438804 0 0 MARK CLEMENT 0 705311 0 633799 0 46064 0 707655 0 4917 0 2097746 0 397500 PAULA TINCH 0 190388 0 43172 0 27597 0 52685 0 4455 0 318297 0 0 JAMES DIGAN 268297 0 190511 0 36448 0 129793 0 1653 0 626702 0 0 0 PART I, LINE 1A CHARTER TRAVEL AND HEALTH & SOCIAL CLUB BENEFITS AS PART OF THEIR COMPENSATION PACKAGE, THE OFFICERS LISTED ON 990, PART VII ARE ELIGIBLE TO UTILIZE SPECIFIC CHARTER TRAVEL ARRANGEMENTS TO CONDUCT BUSINESS OF THE ORGANIZATION. THIS BENEFIT IS UTILIZED TO MAKE THE BEST USE OF THE EXECUTIVE'S TIME WHEN THERE ARE TIME CONSTRAINTS AND/OR LIMITED AVAILABILITY OF NON-STOP FLIGHTS. ALSO, THE FOUNDATION PAYS DUES TO THE GENESEE VALLEY CLUB FOR JAMES DIGAN FOR BUSINESS PURPOSES INCLUDING FOR MEETINGS AND LUNCHEONS RELATED TO FUNDRAISING. THESE BENEFITS HAVE BEEN INCLUDED IN THE EMPLOYEES' FORM W-2 AS TAXABLE COMPENSATION AS REQUIRED. PART I, LINE 3 THE FILING ORGANIZATION'S RELATED NON-PROFIT ORGANIZATION, ROCHESTER GENERAL HEALTH SYSTEM, UTILIZES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B RGHS MAINTAINS A SECTION 457(F) PLAN WHICH WOULD BE CONSIDERED A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2012, NO DISTRIBUTIONS WERE PAID OUT. THE FOLLOWING OFFICERS AND KEY EMPLOYEES LISTED ON FORM 990, PART VII, SECTION A WOULD BE ELIGIBLE PARTICIPANTS IN THE PLAN SINCE THEY WOULD BE ENTITLED TO A DISTRIBUTION UPON SEPARATION FROM SERVICE: MARK CLEMENT X 1 10000 SALE OF COMP PROP X 1 135000 SALE OF COMP PROP X 9670 SALE OF COMP PROP X DISPOSABLE CAMERAS/KODAK EASY SHARE 5000 SALE OF COMP PROP X MEDICAL EQUIPMENT 45985 SALE OF COMP PROP X LOADER 600 SALE OF COMP PROP 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A MEMBERSHIP (NOT A STOCK) CORPORATION UNDER NEW YORK STATE LAW. THE ORGANIZATION'S SOLE CORPORATE MEMBER IS ROCHESTER GENERAL HEALTH SYSTEM (RGHS), A RELATED NOT-FOR-PROFIT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A IN ACCORDANCE WITH THE TERMS AND REQUIREMENTS OF ITS GOVERNING DOCUMENTS (I.E. BYLAWS), THE ORGANIZATION'S DIRECTORS ARE DIVIDED INTO THREE CLASSES, AND THE CLASSES SERVE FOR STAGGERED THREE-YEAR TERMS. AT EACH ANNUAL MEETING, DIRECTORS IN A CLASS ARE ELECTED BY A MAJORITY VOTE OF THE DIRECTORS THEN IN OFFICE. DIRECTORS ARE ELECTED FROM AMONG NOMINEES CHOSEN BY THE GOVERNANCE AND NOMINATING COMMITTEE OF THE FILING ORGANIZATION'S SOLE CORPORATE MEMBER, ROCHESTER GENERAL HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B RGHS, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY INCLUDING THE AMENDMENT OF BYLAWS AND CHARTERS, REMOVAL OF MEMBERS OF THE GOVERNING BODY, AND THE DECISION TO DISSOLVE THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, A COPY OF THE FORM 990 IS PROVIDED TO, AND REVIEWED WITH, ALL MEMBERS OF THE EXECUTIVE COMPENSATION COMMITTEE. THIS REVIEW IS PERFORMED IN CONSULTATION WITH THE ORGANIZATION'S TAX ADVISORS, AND IS BASED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS AND OTHER RELEVANT INFORMATION FOR THE APPROPRIATE TIME PERIOD. FORM 990, PART VI, SECTION B, LINE 12C UPON EMPLOYMENT, ALL EMPLOYEES RECEIVE THE ETHICAL STANDARD OF CONDUCT BOOKLET FOR WHICH THEY SIGN A RECEIPT OF ACKNOWLEDGEMENT. CONFLICT OF INTEREST IS DEFINED, AS IS MANAGEMENT OF A CONFLICT OF INTEREST. EMPLOYEES ARE REQUIRED TO DISCLOSE AND SEEK RESOLUTION TO ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST BEFORE TAKING A POTENTIALLY IMPROPER ACTION AND THEREAFTER, ANNUALLY, EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM, PROVIDING MANAGEMENT WITH SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THAT MANAGEMENT CAN (1) DETERMINE WHETHER ANY ACTUAL OR PERCEIVED CONFLICT OF INTEREST EXISTS, AND (2) MONITOR WORK ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE OR OFFICER IN A POSITION WHERE THERE MAY BE A QUESTION AS TO HIS/HER OBJECTIVITY AS WELL AS TO AVOID ANY APPEARANCE OF IMPROPRIETY. THROUGHOUT THE YEAR, KEY EMPLOYEES AND OFFICERS OF THE ORGANIZATION ARE ALSO REQUIRED TO NOTIFY MANAGEMENT PROMPTLY IF ANY CHANGE TO THEIR DISCLOSURES OCCURS. IN ADDITION, EACH MEMBER OF THE BOARD OF DIRECTORS MUST ALSO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, WHICH MUST BE SUBMITTED TO THE GENERAL COUNSEL. BOARD MEMBERS LEAVE THE ROOM DURING DISCUSSIONS AND ABSTAIN FROM VOTING WHEN THEY HAVE A CONFLICT OF INTEREST. IN ADDITION TO THE BOARD OF DIRECTORS, THE ORGANIZATION'S MANAGERS AND DIRECTORS WHO OVERSEE ITS OPERATIONS COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY AS WELL. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S OFFICER AND KEY EMPLOYEE COMPENSATION ARRANGEMENTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF ROCHESTER GENERAL HEALTH SYSTEM, A RELATED NOT-FOR-PROFIT ORGANIZATION. INFORMATION REVIEWED FOR THE OFFICER/KEY EMPLOYEE INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX EXEMPT ORGANIZATIONS IN THE WESTERN/CENTRAL NY COMMUNITY AS WELL AS COMPENSATION FOR THESE POSITIONS (AS DISCLOSED ON FORM 990) WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE COMPENSATION COMMITTEE IS DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES OF THE AFFILIATED HEALTH SYSTEM AT 100 KINGS HIGHWAY SOUTH, ROCHESTER, NY 14617 AND ADMINISTRATIVE OFFICES OF THE FILING ORGANIZATION. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED. FORM 990, PART XII, LINE 2C: PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. STATEMENT PURSUANT TO TREAS REG SEC 1 60382-2(J)(3) FORM 5471 FILED ON BEHALF OF STATEMENT THE FOLLOWING INFORMATION IS SUBMITTED WITH RESPECT TO ROCHESTER GENERAL HEALTH SYSTEM WORKERS COMPENSATION TRUST'S FORM 5471 (INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS) FILING REQUIREMENT FOR THE ENTITY BELOW. NAME OF FOREIGN CORPORATION GREATER ROCHESTER ASSURANCE COMPANY, LTD BEGINNING TAX YEAR OF FOREIGN CORPORATION JANUARY 1, 2012 ENDING TAX YEAR OF FOREIGN CORPORATION DECEMBER 31, 2012 THE FORM 5471 FILING REQUIREMENT FOR THIS FOREIGN CORPORATION FOR CATEGORIES 4 AND 5 HAVE BEEN SATISFIED BY INCLUSION IN THE FOLLOWING U.S. FILER'S TAX RETURN NAME OF U.S. FILER ROCHESTER GENERAL HEALTH SYSTEMS ADDRESS OF U.S. FILER 100 KINGS HIGHWAY SOUTH ROCHESTER, NY 14617 EIN OR SSN 22-2551509 ENDING TAX YEAR OF U.S. FILER DECEMBER 31, 2012 TYPE OF RETURN FILED 990-T IRS SERVICE CENTER WHERE RETURN FILED OGDEN, UTAH 84201-0027 THE ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVENUE ROCHESTER NY 14621 160743134 HOSPITAL NY 501(C)(3) LINE 3 RGHS 0 ROCHESTER MENTAL HEALTH CENTER 490 EAST RIDGE ROAD ROCHESTER NY 14621 166069131 MENTAL HEALTH NY 501(C)(3) LINE 9 RGHS 0 GRHS FOUNDATION 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963015 R/E INV MGMT NY 501(C)(3) LINE 11B, II RGHS 0 ROCHESTER GENERAL HEALTH SYSTEM 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222551509 SYSTEM PARENT NY 501(C)(3) LINE 11B, II N/A 0 NEWARK WAYNE COMMUNITY HOSPITAL DRIVING PARK AVENUE NEWARK NY 14513 150584188 HOSPITAL NY 501(C)(3) LINE 3 RGHS 0 RGHS WORKERS' COMPENSATION TRUST 1425 PORTLAND AVENUE ROCHESTER NY 14621 166429300 SEE PART VII NY 501(C)(3) LINE 11B, II RGHS 0 CONTINUING CARE NETWORK INC (CCN) 100 KINGS HIGHWAY SOUTH ROCHESTER NY 14617 222963016 SUPPORT RGH NY 501(C)(3) LINE 11B, II RGHS 0 ROCHESTER GENERAL HUDSON HOUSING 2066 HUDSON AVENUE ROCHESTER NY 14617 223210351 LOW INC HOUSING NY 501(C)(3) LINE 9 RGHS 0 INDEPENDENT LIVING FOR SENIORS 2066 HUDSON AVENUE ROCHESTER NY 14617 161491059 ADULT DAY HC NY 501(C)(3) LINE 9 RGHS 0 ROCHESTER GENERAL LONG TERM CARE 1550 EMPIRE BLVD WEBSTER NY 14580 223187140 NH & REHAB NY 501(C)(3) LINE 9 RGHS 0 WESTERN NEW YORK MEDICAL PRACTICE PC 1425 PORTLAND AVENUE ROCHESTER NY 14621 611654232 PHYS PRAC NY 501(C)(3) LINE 9 N/A 0 NEWARK WAYNE COMMUNITY HOSPITAL FOUNDATION DRIVING PARK AVENUE NEWARK NY 14513 222963015 FUNDRAISING NY 501(C)(3) LINE 11B, II NWCH 0 GREATER ROCHESTER ASSURANCE COMPANY LTD GEORGE TOWN GRAND CAYMAN CJ INSURANCE CJ N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROCHESTER GENERAL HOSPITAL B 2869047 FMV RELATED TAX-EXEMPT ORGANIZATION - PRIMARY ACTIVITY SCHEDULE R, PART II, COLUMN B: RGHS WORKERS' COMPENSATION TRUST SUPPORTS THE GENESEE HOSPITAL, ROCHESTER GENERAL HOSPITAL, ROCHESTER GENERAL HOSPITAL FOUNDATION, NEWARK WAYNE COMMUNITY HOSPITAL, NEWARK COMMUNITY HOSPITAL FOUNDATION, INDEPENDENT LIVING FOR SENIORS, ROCHESTER GENERAL LONG TERM CARE, ROCHESTER GENERAL HUDSON HOUSING, GRHS FOUNDATION, BEHAVIORAL HEALTH NETWORK, AND ROCHESTER GENERAL HEALTH SYSTEMS.